title: Visual acuity and microperimetric mapping of lesion area in eyes with inflammatory cystoid macular oedema.
abstract: OBJECTIVE
  To evaluate the effect of fluid accumulation on local visual function in inflammatory cystoid-macular-edema (ICME).
  
  
  METHODS
  This cross-sectional study applied optical-coherence-tomography over a 12×12 fovea-centered field in 50 patients with ICME and mapped the extent of fluid-filled spaces in various retinal layers, of subretinal-fluid and of diffuse-edema. Regression analysis examined effect of planimetric fluid-distribution on best-corrected-visual-acuity (BCVA) and mean microperimetric-sensitivity.
  
  
  RESULTS
  BCVA decreased with increasing central-neuroretinal-thickness (r= 0.52, p= 0.001), total central-retinal-thickness, including subneuroretinal-fluid (r= 0.41, p= 0.006), total cystoid-and-diffuse edema-area (r= 0.35, p= 0.036) and cystoid inner-nuclear-layer area (r= 0.39, p= 0.02). Mean retinal-sensitivity decreased with increasing diffuse edema-area (r= -0.86, p<0.0001), total cystoid-and-diffuse edema-area (r= -0.54, p= 0.001), cystoid inner-nuclear-layer area (r= -0.46, p= 0.008) and cystoid ganglion-cell-layer area (r= -0.6, p=0.049), central-neuroretinal-thickness (r= -0.42, p= 0.028) and total central-retinal-thickness (r= -0.34, p= 0.039). In multivariate-analyses BCVA was best described by central-neuroretinal-thickness, duration of edema, total cystoid-and-diffuse edema-area and cystoid inner-nuclear-layer area (R(2) = 0.5, p= 0.002). Mean retinal-sensitivity was best described by diffuse edema-area, total cystoid-and-diffuse edema-area and central-neuroretinal-thickness (R(2) = 0.75, p< 0.0001). Subretinal-fluid area and cystoid outer-nuclear/Henle's layer area had no effect on either BCVA or microperimetry.
  
  
  CONCLUSIONS
  Thickening of the neurosensory-fovea, not subfoveal-fluid, had major impact on both BCVA and retinal-sensitivity. The extent of edema in inner retinal layers also had major impact on both of these two functional parameters. Visual-impairment seems to differ depending on the layers involved, thus different types of fluid accumulation may potentially be given varying treatment priorities.
authors.affiliation: Department of Ophthalmology, Medical University of Vienna, Vienna, AustriaCenter for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, AustriaDepartment of Ophthalmology, Glostrup Hospital, Glostrup, DenmarkFaculty of Health and Medicine, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Marion R
authors.initials: MR
authors.lastname: Munk
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Kiss
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Huf
authors.forename: Alessio
authors.initials: A
authors.lastname: Montuoro
authors.forename: Florian
authors.initials: F
authors.lastname: Sulzbacher
authors.forename: Maria
authors.initials: M
authors.lastname: Kroh
authors.forename: Michael
authors.initials: M
authors.lastname: Larsen
authors.forename: Ursula
authors.initials: U
authors.lastname: Schmidt-Erfurth
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D005584:Fovea Centralis; D006801:Humans; D008269:Macular Edema / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012160:Retina / Q000503:physiopathology*; D058471:Subretinal Fluid / Q000502:physiology; D041623:Tomography, Optical Coherence; D014605:Uveitis / Q000503:physiopathology*; D014792:Visual Acuity / Q000502:physiology*; D058609:Visual Field Tests / Q000379:methods*; D014794:Visual Fields / Q000502:physiology*
keywords: Irvine-Gass; SD-OCT; cystoid macular oedema; retinal sensitivity; uveitic-associated CME; visual acuity